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Improper Payments: Responses to Posthearing Questions Related to Eliminating Waste and Fraud in Medicare and Medicaid

GAO-09-838R Published: Jul 20, 2009. Publicly Released: Jul 20, 2009.
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On April 22, 2009, GAO testified before the subcommittee at a hearing entitled, "Eliminating Waste and Fraud in Medicare and Medicaid." This letter responds to a May 29, 2009, request for responses to questions for the record related to our April 22, 2009, testimony. The questions are as follows: (1) What do you see as the biggest challenge for CMS to provide an estimate for improper payments under Medicare Part D? (2) Has GAO identified any problems with the current process for reviewing and paying Medicare claims that would make the program more vulnerable to fraudulent claims? (3) Is there any reason CMS cannot include penalties in its Medicare Administrative Contractor contracts for paying improper or fraudulent claims that you are aware of?

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Claims processingClaims settlementContractor violationsCost plus award fee contractsErroneous paymentsFederal regulationsFines (penalties)FraudHealth care programsInternal controlsMedicaidMedicareProgram abusesQuestionable paymentsRequirements definitionStandardsWaste, fraud, and abuse